Health Leaders Rally Supporters to Continue Transforming Nursing

Three years into a national movement to transform the nursing profession to improve health and health care, leaders came together last week to give a pep talk to rally supporters.

Donna Shalala, PhD, FAAN, president of the University of Miami in Florida, former head of the U.S. Department of Health and Human Services, and chair of the Committee on the Robert Wood Johnson Foundation (RWJF) Initiative on the Future of Nursing, urged nurses and their allies to “seize the opportunity” to transform nursing. “The future of nursing is the future of health care, and that future is now,” she said. Her remarks were delivered on Dec. 11 as the highlight of the Institute of Medicine’s (IOM) 2013 Richard & Hinda Rosenthal Lecture in Washington, D.C.

RWJF President and CEO Risa Lavizzo-Mourey, MD, MBA, echoed the sentiment in recorded remarks that concluded the lecture. “When you get to this stage in the game, you start to get tired, you wonder if you’re actually getting anywhere, if it’s possible to push any farther,” she said. “The answer is yes.”

The call to action comes three years after the IOM released a groundbreaking report that recommended a radical transformation of the nursing profession to improve access for all to higher quality, safer, more affordable and more patient-centered health care. The report recommended changes in the areas of nursing practice, education, leadership, data, diversity, and interprofessional education and collaboration. It serves as the foundation of a national campaign to implement its recommendations. The campaign’s goal is that everyone in America can live a healthier life, supported by a system in which nurses are essential partners in providing care and promoting health.

In addition to remarks by Shalala and Lavizzo-Mourey, some of the nation’s top nurses and doctors celebrated the Future of Nursing: Campaign for Action’s victories and addressed its challenges during a panel discussion moderated by IOM President Harvey Fineberg, MD, PhD.

The first victory came the day the report was released in October, 2010. That day, the IOM received some 11,000 hits—a number so large that it temporarily stalled the IOM website, Fineberg said. Since then, The Future of Nursing: Leading Change, Advancing Health has been the IOM’s most downloaded report and is “the benchmark against which any other report measures its success.”

Another major victory came two months later, when RWJF and AARP joined forces in December, 2010, to launch the Campaign for Action, a massive, multi-faceted effort to implement the report’s recommendations at the local, state, and national levels. Since then, Action Coalitions—groups of nurses, health providers, consumers, businesses, and allies from other sectors—have taken shape in all 50 states and in the District of Columbia. “The kind of follow-up this report has gotten is really unmatched in my experience,” Shalala said.

Ever since, the Campaign has unleashed what Fineberg called a “torrent of activity” aimed at implementing the report’s key recommendations, which include: enabling nurses to practice more freely so they can expand access to care; helping more nurses earn advanced degrees so they can provide better care; enhancing the diversity of the nursing workforce to better reflect the population it serves; developing nurse leaders so they can have a larger say at decision-making tables; collecting richer data about the nursing workforce; and promoting interprofessional education and practice to better enable nurses, doctors, and other health professionals to practice as members of well-functioning teams.

Campaign Progress

Progress, Shalala said, has been made on every front. Victories include the removal of barriers to the practice of advanced practice registered nurses (APRNs) in seven states; more streamlined education programs that make it easier for nurses to advance their education; and the appointment of more nurses to decision-making boards. “This is exactly the kind of change we envisioned,” she said.

Other markers of progress include the fact that the report continues to have a presence in mainstream media outlets and has influenced major organizations such as the American Hospital Association, the National Governors Association, and the American Red Cross, said Susan B. Hassmiller, PhD, RN, FAAN, senior adviser for nursing at RWJF and director of the Campaign for Action.

Linda Burnes Bolton, DrPH, RN, FAAN, vice president and chief nursing officer at Cedars-Sinai Medical Center in Los Angeles and a member of the RWJF Board of Trustees, added during the panel discussion that the campaign has succeeded in bringing the larger nursing community together in new ways.

And more states are coming to the realization that they need to allow nurse practitioners to practice as independent providers, said Carmen Alvarez, PhD, RN, NP-C, CNM, the Julio Belber Postdoctoral Fellow in the Department of Health Policy at the George Washington University in Washington, D.C.

David Vlahov, PHD, RN, FAAN, dean and endowed professor of nursing education at the School of Nursing at the University of California, San Francisco, cited growth in the number of students in, and graduates of, baccalaureate and doctoral nursing education programs. He said there is a new emphasis in nursing school curricula on interprofessional education and health care policy.

But barriers remain, according to panelists. Opposition to the report and to the campaign from organized medicine continues, according to Darrell Kirch, MD, president and CEO of the Association of American Medical Colleges. And entrenched payment systems are “rife with perverse incentives” that “increase tension between disciplines” rather than foster integration, he added. “I found the report very valuable, but it wasn’t universally well-received in my profession, for reasons that are inexplicable to me.”

Other panelists listed challenges such as lack of funding and insufficient clinical placements for nursing students; an education system that in large part does not prepare health professions students to practice together as members of health care teams; and initial concerns at community colleges over efforts to encourage more nurses to get baccalaureate and higher degrees, which are typically offered in university settings.

“While we’ve come far, we are far from the end,” Lavizzo-Mourey said. But she concluded on an upbeat note: “Nurses belong at the center of transformative change in health and health care. The way forward will be challenging, but I know we will succeed.”

More than 1,000 people viewed the lecture online, and 350 attended in person. Several Action Coalitions gathered supporters to view it live.